Evaluation of the efficiency of corticosteroids in treating adult with sepsis: A protocol for systematic review and meta-analysis.

BACKGROUND: Sepsis is a worldwide health problem that is a leading cause of mortality due to infection. Sepsis is prevalent in infections that are complicated with organ failure. Generally, sepsis is intricate and impaired corticosteroid metabolism leads to complex outcomes. Therefore, the provision of corticosteroids could lead to improved clinical outcomes. The effect of corticosteroids therapy in adult patients with sepsis is not well studied. Therefore, this study is an attempt to evaluate the efficacy of corticosteroids for treating adult cases of sepsis. METHODS: We will systematically search the randomized controlled trials for potential eligible studies from online databases, which includes 5 English databases (PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Library) and 4 Chinese databases (China National Knowledge Infrastructure, WanFang Database, VIP information database, and China Biomedical Database) from their origin to March 2021. Languages were restricted to English and Chinese. Two independent authors will be screening the literature, collect, and perform data extraction and quality assessment. Data will be synthesized using appropriate statistical methods. RESULTS: This study will summarize present evidence to evaluate the efficacy of corticosteroids for the treatment of adult cases of sepsis. CONCLUSION: The results of the present study will provide the latest, reliable, superior quality evidence for the clinical application of corticosteroids for treating sepsis patients. ETHICS AND DISSEMINATION: The present study will use published data and does not require ethics approval. PROTOCOL REGISTRATION NUMBER: March 28, 2021.osf.io/tm6sw. (https://osf.io/tm6sw/).

Kinematic Characteristics and Biomechanical Changes of Lower Lumbar Facet Joints Under Different Loads.

OBJECTIVE: To explore the kinematic biomechanical changes and symmetry in the left and right sides of the facet joints of lumbar spine segments under different functional loads. METHODS: Participants (n = 10) performing standing flexion and extension movements were scanned using computed tomography (CT) and dual fluoroscopy imagine system. Instantaneous images of the L3 -S1 vertebrae were captured, and by matching a three-dimensional CT model with contours from dual fluoroscopy images, in vivo facet joint movements were reproduced and analyzed. Translations and rotations of lumbar vertebral (L3 and L4 ) facet joints of data were compared for different loads (0, 5, 10 kg). The participants performed flexion and extension movements in different weight-bearing states, the translations and angles changes were calculated respectively. RESULTS: From standing to extension, there were no statistical differences in rotation angles for the facet joint processes of different vertebral segment levels under different weight loads (P > 0.05). Mediolateral axis and cranio-caudal translations under different weight loads were not statistically different for vertebral segment levels (P > 0.05). Anteroposterior translations for L3 (1.4 ± 0.1 mm) were greater than those for L4 (1.0 ± 0.1 mm) under the different load conditions (P = 0.04). Bilaterally, mediolateral, anteroposterior, and cranio-caudal translations of the facet joints under different weights (0, 10 kg) for each segment level (L3 and L4 ) were symmetric (P > 0.05). From flexion to standing, there were no statistical differences in rotation angles for different weights (0, 5, 10 kg) for each level (L3 and L4 ) (P > 0.05). There were no statistical differences between mediolateral, anteroposterior, and cranio-caudal translations at each segment level (L3 and L4 ) under different loads (P > 0.05). Under the condition of no weight (0 kg), L3 mediolateral translations on the left side (1.7 ± 1.6 mm) were significantly greater (P = 0.03) than those on the right side (1.6 ± 1.6 mm). Left side (1.0 ± 0.7 mm) L4 mediolateral translations were significantly smaller (P = 0.03) than those on the right side (1.1 ± 0.7 mm). There were no statistical differences between different weights for either anteroposterior and cranio-caudal translations (P > 0.05). There were no statistical differences for mediolateral, anteroposterior, and cranio-caudal translations for 10 kg (P > 0.05). CONCLUSION: Lumbar spine facet joint kinematics did not change significantly with increased loads. Anteroposterior translations for L3 were greater than those for L4 of the vertebral segments are related to the coronal facet joint surface. Changes in facet surface symmetry indicates that the biomechanical pattern between facet joints may change.

Multiple cardiac arrests induced by pulmonary embolism in a traumatically injured patient: A case report and review of the literature.

RATIONALE: Pulmonary embolism-induced cardiac arrest should not be given up arbitrarily, knowing that the etiology of pulmonary embolism is reversible in most cases. PATIENT CONCERNS: We present a case of continuous resuscitation lasting approximately 4 hours, during which 21 episodes of cardiac arrest occurred in a 46-year-old man who sustained high-level paraplegia after a road traffic accident. DIAGNOSES: Multiple cardiac arrests induced by pulmonary embolism. INTERVENTIONS: The patient received cardiopulmonary resuscitation and thrombolytic therapy. OUTCOMES: The patient was discharged in 2 weeks when his condition turned for the better. LESSONS: Cardiopulmonary resuscitation of patients with pulmonary embolism-induced cardiac arrest should not be given up arbitrarily, knowing that the etiology of pulmonary embolism is reversible in most cases. Effective external cardiac compression can not only save the patient's life but also attenuate neurological sequelae. Thrombolytic therapy is the key to the final success of resuscitation.